MEDICARE: HOSPICE BRAZOS VALLEY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	2186	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2186	OTHER	TX	DEPT. OF AGING
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043633746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE BRAZOS VALLEY, INC.

Provider Business Mailing Address
First Line	:	502 W 26TH ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-2426
Country	:	US
Telephone Number	:	979-821-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 W 26TH ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-2426
Country	:	US
Telephone Number	:	979-821-2266
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. CRAIG BORCHARDT
Credential	:	PH.D.
Telephone Number	:	979-821-2266

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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Directions to “HOSPICE BRAZOS VALLEY, INC. ” Practice Location

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